WAS967

If she even gets past a preliminary hearing I will laugh. And if she does, I humbly request that every one of us go to her lawyer and demand class action status, so that if she ever sees a dime, she has to split it with the rest of us.

Speaking of surround sound....a bit of trivia about the shuttle launch. The area around the launch pad for a 2 mile radius is cleared of everyone, not because of the blast, but because of the NOISE. Despite a sound suppression system under the pad (if you ever see the view from the bottom of the shuttle, and wonder what all that water is pouring into there - thats the sound suppresion system) it still puts off one heck of a roar. I'd LOVE to see a launch in person one day.

Due to further cutbacks, the helo will be left it "auto-hover" mode and equipped with an electric winch. The Pilot (who is also a medic) will lower himself down to the scene, perform "vital vision" while loading the patient into the basket and then be lifted up with the patient to the helicopter all while it magically hovers overhead unmanned. ALS will be performed enroute to the hospital with the medic using his arms for the ALS and his feet to fly. (One can imagine the position required for same). Pictures to come soon.

I believe the reservation also includes the WCC campus.

The reason a lot of the ER doctors we had grown familiar with left is because there was a change in the contract and a new physician's group based out of NJ (the name escapes me) is now providing docs for WMC's ER. They are the same group that provides the MDs for HVHC, so it's not uncommon to see some of the docs from HVHC working at WMC.

Gratz Seth, and best wishes on your new lives together. I just celebrated my 5th wedding anniversary.It goes by very quickly. Enjoy being a newlywed now before the novelty wears off. (PS...Thank you for not streaming the honeymoon)

They are just rewriting them NOW? Good grief. They should have been done LAST YEAR. Problem too is they have to be approved byt the REMAC here then sent upstate to be approved by the SEMAC. We'll get new protocols just in time for the 2009 guidelines.

Just an FYI on the crotalid antivenom.......it is VERY expensive (in the order of $1-2k per vial. Dosage is by the VIAL and usually requires multiple vials of Crofab. MOST local hospitals only carry one or two of the vials to get the treatment started. From there they will likely be shipped to Jacobi if it is proven to be a poisonous bite. (Yes, I have called local hospital Pharmacys and inquired)

I am happy to hear they were caught. (What does this have to do with EMS?)

Phil, NWH/WEMS - Third Thursday of every month - 7pm @ WEMS HQ (Usually Dr. Marcus but sometimes Dr. Haydock or Dr. Grayson) HVHC/CRP - Third Tuesday of every month - 7pm @ Wagner Conference Room @ HVHC Phelps - Third Wednesday of every month - 6pm for BLS, 7pm for ALS (Both can be applied to your ALS requirement as they are both overseen by Dr. Nigro) WPHC/WCDES - Every Friday @ 9am at WCDES Dana Rd Also, get out your CME sheets and have a MC-MD fill one out for each ALS call you do. You can get up 4 hours I believe and each is worth 0.25 credit. As a stopgap measure, why not throw together a last minute mega audit of your own? Hold a 10-13 (you do need assistance right? ) audit at a local place and invite the local EMS community. I'm sure you will get quite an attendance if you do 3-4 hours in a row. All you need is a friendly doc to do it for you.

This actually does require a rather strong magnet so the typical fridge magnets won't work. You might see them in the ER stuck to a cabinet in the RN station....they are round blue and donut shaped and remind me a bottle opener. There is a technique for swiping the magnet over the device itself but I have never done it so can't state what it is. Food for thought for the ALS providers - if you have a patient that tells you they were shocked by their ICD - would you give them antiarrhythmics enroute to the hospital? Why or why not?

CPAP/BiPAP definatly ranks high on my list of things I'd like to see WCREMAC put into their protocols. (An AHA 2005 Guideline compliant protocol would be #1 BTW.)

Regarding the tube holders: I have used both and each has it's pros and cons. I'll never forget the time I woke up an intubated respiratory arrest with narcan and had him bite right through the Ambu holder's bit block. Cheap plastic makes for a cheap holder. The Thomas one seems much more rigid. Downside to both is you can't use it for nasal tubes because of the bit block (if it weren't there on the thomas, it would work quite well actually - not sure of the mabu as I have not used it in a while. The definite pro of the ambu is the one handed use, just get the one with the velcro strap, not the blue rubber. I've actually had some problems with the velcro strap on the Thomas holder, but thaty can be overcome, since the more important part is the holder itself not the strap. In the end it really comes down to personal preference, trying both out, and seeing what you like. Personally, I'd go for the Thomas. But either beats the pants off tape. YMMV. As for the autopulse, I love it. It frees up hands to do other things. Only problem I've ever had with it is the strap breaking, but thankfully we were already at the ED. I still remember using the Thumper way back when Peekskill had one. Only thing I would miss about it is the fact that it "Breaths" as well and "pushes" for those patients who are intubated. But that just leads to a bored EMT on the ride to the hospital. Cost will be a downside to the Autopulse for some time until they sell more units and it drives down the retail price. It has already come down a bit from when Mohegan original was part of the pilot program - they were $25k then I believe. So a few more years and I think they will become more and more common place, especially now with more and more emphasis being put on good chest compressions over all else.

Technically the new protocol has been in effect since it was released by the state back around February. July 1st is the date that all agencies are required to be compliant with the new protocols, carry the ASA, and have their people in serviced. HOW they are in serviced is left entirely up the the medical director of the agency. Paperwork is the key here as that is what the state will be looking at during site inspections. Haven't heard of this one until now. I'll have to look into it. Probably won't affect us as much in Westchester since a majority of the time it's quicker to go by ground to WMC. I'd be more interested in seeing a statewide protocol for diversion to a heart center for any case of 12-lead identified STEMI, regardless of mode of transport. The fact that we can divert to designated stroke centers, burn centers, and trauma centers but not heart centers is ridiculous. Sounds about right. And since it is a statewide protocol, EVERY ambulance SHOULD have it. And here is the kicker - the training is agency specific. So if you take an ASA update at XVAC, it doesn't AUTOMATICALLY apply to YVAC. HOWEVER, with the proper paperwork from the in-service that you DID complete, your other agency medical director can approve of the training you took elsewhere, and waive training at the second agency. It all comes down to what your medical director allows. Confused? So are a lot of people. Get even more confusing when, TECHNICALLY, the medics are supposed to do the ASA update also! Right there with you on the dose option. In fact the dose option is incorrect. It should be 162 mg, not 160mg, but hey. Who's checking? (Not the SEMAC docs apparently). The reason we were told that they put the dose option in there is (supposedly) for agencies that, for one reason or another - don't ask why - only have the 325mg ASA dosage. However, in the letters from the SEMAC, it states that your SUPPOSED to carry the 81mg Chewable tablets. So no idea why they would only have the 325mgs. As far as efficacy of a 162mg dose, thats quite controvertible. There are some "camps" that have been teaching that 81mg dosage for MOST patients is adequate enough to eliminate the aggregation of 90% of your platelets, and 162mg will be fine for most. Ergo why most patients take 81mg a day. You get a leap frog effect. (If that makes sense). Many would actually argue that 325mg is overkill. But who the heck knows? In the end, erring on the side of caution and giving a full 325mg, regardless of prvious intake, won't harm them in the absense of complications (sensitivity, GI bleed, etc). The PSE sheet is only meant as a guideline for what agencies should use as practical testing for their people. If an agency feels the need to add a point for specifically asking about previous intake, they may. And techincally it DOES ask, as it requires the candidate to state the indications and contraindications for ASA administration, one of which is ASA intake within the past 24-48 hours.

Via bedpan. Usually flung at us by an angry nurse for coming in when "we shouldn't have". Love my job. I love my job. I love my job. (I don't carry a gun for a reason).

To the dispatchers at 60 control. Thank you for your hard work and patience, especially with the above mentioned road block to clear communications. I am dispatched by and work with you all at two different agencies and have seen the professionalism only increase over the past 10 years. If I ever seem short, it's not your fault, it's most likely the radio. On both sides of the county (especially the eastern half) I often feel like communications would best be effected by smoke signal. I know Dave can hear through the static, but the rest of us can't. One day we'll all be talking via satellite, and all will be good. Keep up the good work.

http://en.wikipedia.org/wiki/High_Definition_Radio

Yup. Simple Photoshop or GIMP filter. Don't have Photoshop? Get the GIMP! http://www.gimp.org/windows/

Tommy, I agree with you. It is BS, but unfortunately it's the truth. Ask half the MC docs out there what they think about giving Paramedics RSI. The opinions will astound you. Hell, our very own Paramedic director is at the forefront of not allowing us to do RSI. Is it any wonder we haven't seen it materialize?

You sure about that? I know the name of the agency needs to appear on three sides of the vehicles, but I do not recall a requirement that it be the most predominant name on the vehicle. On the WEMS ambulances, the names of the hospitals take up far more real estate than the name of the company.

I'm sorry but that is one ugly ambulance. Sorry guys.

On the not-so-flip-side, here is a study from France that seems to indicate no difference in efficacy between Etomidate and Benzodiazapines. With this in mind, I would say Etomidate would make a better choice since 1) you could give it on standing order - Versed you can't since SEMAC won't allow any controlled substance on standing order aside from Valium for status and 2) some agencies just don't carry enough Versed to be effective (my primary agency only usually carries 4mg).

Interesting info from upstate relating to Etomidate vs Diazepam: From http://www.ingentaconnect.com/content/tand...10?crawler=true

Could you tell us more about the down sides? I'd love to know what complications it causes. (Seriously, not being facetious). I really hope we get some kind of MAI down here as I've had plenty of calls where we could have genuinely used it, and when you have a 20+ minute transport to the ER, it needs to be done sooner than later. There is talk about adding Etomidate to the WC protocols as an MAI measure since a lot of the docs are still skeptical to allowing medics to paralyze someone when they don't intubate as often as they want them to. RSI is good in areas where the medics are dropping tubes every other week, but in areas up north, where you maybe intubate once a month at most, I can understand their skepticism.

I would have written her for the broken headlight. She can easily get out of that. She knows it's broken and that she needs to get it fixed. She just needs an attitude adjustment as all. I think that would do it. If she gets it fixed and the ticket signed by sundown the next day, it disappears. Simple.